Elif ÖZALKAYA, Hande Özgün KARATEPE, Taner YAVUZ, Selahattin AKAR, Emine KAVAS, Güner KARATEKİN

Hidrops Fetalis'li Supraventriküler Taşikardinin Tedavi Zamanlaması: İntrauterin mi? Ekstrauterin mi?

Fetal taşikardi'nin %90 nedeni supraventriküler taşikardidir. Kalp hızı 220/dk üzerinde ve süreklilik gösterirse taşikardiye %40 hidrops fetalis eşlik eder. Serebral komplikasyonları önlemek için fetal taşikardinin erken dönemde kontrol altına alınması gerekir. Ancak hidrops fetalisin eşlik ettiği taşikardinin intrauterin tedavisi zor ve mortalitesi yüksektir. 32 haftalık sezaryan ile 1990 gram doğan erkek bebeğin hidrops fetalis ve fetal taşikardisi antenatal 30. gebelik haftasında dış merkezde saptanmıştı. Postnatal kalp monitorizasyonu ile izlenen bebeğin 48. saatinde supraventriküler taşikardisi gelişti. Üçlü antiaritmik tedavi ile supraventriküler taşikardi ve hidrops fetalis bulguları geriledi. Biz bu prematüre olguyu, hidrops fetalis'li supraventriküler taşikardi tedavisini ve zamanlamasını tartışmak amacı ile sunduk

The Right Timing of The Treatment of Supraventricular Tachycardia Accompanied by Hydrops Fetalis: Intrauterine or Extrauterine?

Ninety percent of fetal tachycardia is caused by supraventricular tachycardia. If the heart rate is over 220 /minute and persistent, 40% of it is accompanied by hydrops fetalis. Fetal tachycardia should be controlled at early period to prevent serebral complications. But intrauterine treatment of tachycardia which is accompanied by hydrops fetalis is difficult and mortality of it is high. Our patient was born by cesarean section at 32 gestational week with birth weight of 1990 grams. Hydrops fetalis, fetal tachycardia was determined antenatally at 30th gestational week in another center. At the 48th hour after birth, supraventricular tachycardia was observed. The symptoms of supraventricular tachycardia and hydrops fetalis were controlled by triple antiarrhythmic therapy. We present this case to discuss the treatment of supraventricular tachycardia complicated by hydrops fetalis and the best time for treatment

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Krapp M, Kohl T, Simpson M, Sharland GK, Katalinic A, Gembruch U. Review of diagnosis, treatment and otcome of fetal atrial flutter compored with spraventricular tachycardia. Heart 2003; 89: 913-917.
Hahurij ND, Blom NA, Lopriore E. Perinatal management and long term cardiac outcome in fetal arrhythmia. Early Hum Dev 2011; 87:83-87.
Simpson JM, Sharland GK. Fetal tachycardias:management and outcome of 127 consecutive cases. Heart 1998; 79: 576-581. 4. Naheed ZJ, Strasburger JF, Deal BJ, Benson DW, Gidding SS. Fetal tachycardia:mechanisms and predictors of hydrops fetalis. J Am Coll Cardiol 1996; 27: 1736-1740.
Parilla BV, Strasburger JF, Socol ML. Fetal supraventricular tachycardia complicated by hydrops fetalis: a role for direct fetal intramuscular therapy. Am J Perinatol. 1996;13(8):483.
Shah A, Moon-Grady A, Bhogal N, Collins KK, Tacy T, Brook M, Hornberger LK. Effectiveness of sotolol as first-line therapy for fetal supraventricular tachyarrhythmias. Am J Cardiol. 2012 ;109:1614-1618.
Strizek B, Berg C, Gottschalk I, Herberg U, Geipel A, Gemb- ruch U. High-dose flecanaide is the most effective treatment of fetal supraventricular tachycardia. Heart Rhythm. 2016 .
Strasburger JF, Cuneo BF, Michon MM, Gotteiner NL, Deal BJ, McGregor SN, Qudijk MA, Meijboom EJ, Feinkind L, Hus- sey M, Parilla BV. Amiodorone therapy for drug-refractory fe- tal tachycardia. Circulation. 2004; 109:375.
Frohn-Mulder IM, Stewart PA, Witsenburg M, Den Hollan- der NS, Wladimiroff JW, Hess J. The efficacy of flecainide ver- sus digoxin in the management of fetal supraventricular tachy- cardia. Prenat Diagn 1995;15: 1297-302.
Van Engelen AD, Weijtens O, Brenner JI, Kleinman CS, Copel JA, Stoutenbeek P et.al. Management outcome and fol- low-up of fetal tachycardia. J Am Coll Cardiol; 1994; 24:1371- 1375.
Oudijk MA, Michon MM, Kleinman CS, Kapusta L, Stouten- beek P, Visser GH et.al. Sotalol in the treatment of fetal dysrhyt- hmias. Circulation 2000; 101: 2721-2726.
Sonesson SE, Fouron JC, Wesslen-Eriksson E, Jaeggi E, Winberg P. Foetal supraventricular tachycardia treated with sotalol. Acta Paediatr 1998; 87: 584-587.
Kang SK, Howe D, Coleman M, Roman K, Gnanapragasam J. Foetal supraventricular tachycardia with hydrops fetalis:a role for direct intraperitoneal amiodorone. Cardiology in the Young 2014; 25; 447-453.
Naumburg E, Riesenfeld T, Axelsson O. Fetal tachycardia: intrauterine and postnatal course. Fetal Diagn Ther 1997; 12: 205-209.
Valerius NH, Jacobsen RJ. Intrauterine supraventricular tachycardia. Acta Obstet Gynecol Scand 1978; 57:407-410.
Uzun O, Babaoğlu K, Sinha A, Massias S, Beattie B. Ra- pid control of fetal supraventricular tachycardia with digoxin and flecainide combination treatment. Cardiol Young 2012; 22: 372-380.
Krapp M, Baschat AA, Gembruch U, Geipel A, Germer U. Flecainide in the intrauterine treatment of fetal supraventricu- lar tachycardia. Ultrasound Obtet Gynecol 2002; 19: 158-164. 18. Hansmann M, Gembruch U, Bald R, Manz M, Redel DA. Fetal tachyarrhythmic: transplacental and direct treatment of the fetus a report of 60 cases. Ultrasound Obstet Gynecol 1991; 1: 162-168.